[gotnurse333]

Can someone explain how to do the basic heparin drip rate calculation and then rate change adjustment based on pTT? I'm still so confused about that!

[JohnW]

Originally Posted by gotnurse333

Can someone explain how to do the basic heparin drip rate calculation and then rate change adjustment based on pTT? I'm still so confused about that!

It really depends, most institutions have a Sliding Scale heparin order sets that tell you how much to go up or down the gtt based on the ptt. As the nurse, there is no set calculation that you need memorize.

[wayunderpaid]

If you look at the order it will state something of this sort:

for a ptt of 80-109 sec leave rate unchanged (all you have to do is check labs). If first therapeutic dose, recheck in 6 hours, if second, recheck in a.m.
for a ptt of 60-79 increase rate by 170 units/hr (1.7 ml/hr), recheck ptt in 6 hours. (numbers vary)
Of course, for higher dose, you will see a decrease. ml/hrs are set by md's according to weight?? I suppose. Some orders ask you to hold it for 1/2 h (if ptt is really elevated). Some ask you to bolus patient to get to a therapeutic level faster.
Remember that a heparin therapeutic level is usually 2.0-2.5 higher than a normal levels.
People on heparin drips need to be monitored for bleeding. Usually cardiac patients, so full cardiac assessment, etc.

All you have to do is look at the labs and follow the order (and question the order if it is inappropriate). Not too long ago a provider did not enter the parameters in the sliding scale, a secretary transcribed the order, and an RN signed it! When I got the patient, heparin had not been hanged yet. So you bet I called!

[GrumpyRN63]

It's normally 25,000 Units in 250 cc's NS, gives you a 100 Units per cc ratio. Goal is usually ptt of around 60, PTT is usually checked q 6 hrs til therapuetic , adjusted and changes depends on MD where I work, rates --for example infusion is at 11cc/hr (=1100 Units/hr), rate may be bumped up by 1 ( to 12cc/hr) and recheck Ptt in 6 hrs. sometimes if ptt very prolonged, may hold for an hr and restart at lower rate